Open Enrollment Benefits 2014-2015 August 1 _ 31, 2014
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Transcript of Open Enrollment Benefits 2014-2015 August 1 _ 31, 2014
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Open Enrollment Benefits2014-2015
August 1_31, 2014
Wylie ISD
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Agenda
• Outline changes to medical and prescription plan design
• Show side-by-side comparison of medical options
• Walk through dental, vision, and other benefit offerings
• Provide dates and times for onsite enrollers
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CHANGES TO MEDICAL/RX PLAN DESIGN
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Medical/Rx Plan ChangesActiveCare 1-HD
Plan Feature From 2013-2014 Plan Year
To 2014-2015 Plan Year
Individual Deductible $2,400 $2,500
Family Deductible $4,800 $5,000
Individual Out-of-Pocket MaxFamily Out-of-Pocket Max
$3,850$4,200
(Out-of-pocket maximums do not include medical copays & deductibles)
$6,350$9,200
(Out-of-pocket maximums include medical copays,
deductibles, and coinsurance)
Teladoc Physician Services N/A $40 consultation fee applies to deductible and
OOP expenses
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Medical/Rx Plan ChangesActiveCare 2 – “ActiveCare Select” Comparison
Plan Feature From 2013-2014 Plan Year
To 2014-2015 Plan Year
Plan Name ActiveCare 2 ActiveCare Select
Individual Deductible $1,000 $1,200
Family Deductible $3,000 $3,600
Individual Out-of-Pocket MaxFamily Out-of-Pocket Max
$4,000$8,000
(Out-of-pocket maximums do not include medical copays &
deductibles)
$6,350$9,200
(Out-of-pocket maximums include medical copays, deductibles, and
coinsurance)
Teladoc Physician Services N/A $40 consultation fee applies to deductible and OOP expenses
Specialist Office Visit Copay $50 $60
Retail Short-Term Brand CopayRetail Maintenance Brand CopayMail Order & Retail-Plus Brand CopaySpecialty Drugs
$65$80
$180$200 per fill
50% coinsurance50% coinsurance50% coinsurance20% coinsurance
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Medical/Rx Plan ChangesActiveCare 2
Plan Feature 2013-2014 Plan Year 2014-2015 Plan Year
Plan Name ActiveCare 2 ActiveCare 2
Individual Deductible $1000 $1,000
Family Deductible $3000 $3,000
Individual Out-of-Pocket MaxFamily Out-of-Pocket Max
$4,000$8,000
(Out-of-pocket maximums do not include medical copays & deductibles)
$6,000$12,000
(Out-of-pocket maximums include medical copays, deductibles, and coinsurance)
Teladoc Physician Services N/A 100% covered
Primary Care Office Visit CopaySpecialist Office Visit Copay
$30$50
$30$50
Prescription Drug Deductible $0 for generic drugs, $200 per person for brand-name drugs
$0 for generic drugs, $200 per person for brand-name drugs
Retail Short-Term (up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)
$20$40$65
$20$40$65
Retail Maintenance (after second fill up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)
$25$50$80
$25$50$80
Specialty Drugs $200 per fill $200 copay up to 31-day supply, $450 copay for 32-90 day supply
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Medical/Rx Plan ChangesActiveCare 3 – “ActiveCare 2”
Plan Feature 2013-2014 Plan Year 2014-2015 Plan Year
Plan Name ActiveCare 3 ActiveCare 2
Individual Deductible $300 $1,000
Family Deductible $900 $3,000
Individual Out-of-Pocket MaxFamily Out-of-Pocket Max
$4,000$8,000
(Out-of-pocket maximums do not include medical copays & deductibles)
$6,000$12,000
(Out-of-pocket maximums include medical copays, deductibles, and coinsurance)
Teladoc Physician Services N/A 100% covered
Primary Care Office Visit CopaySpecialist Office Visit Copay
$20$30
$30$50
Prescription Drug Deductible $75 per person $0 for generic drugs, $200 per person for brand-name drugs
Retail Short-Term (up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)
$15$35$60
$20$40$65
Retail Maintenance (after second fill up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)
$25$50$80
$25$50$80
Specialty Drugs $200 per fill $200 copay up to 31-day supply, $450 copay for 32-90 day supply
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SIDE-BY-SIDE VIEW OFMEDICAL/RX PLAN DESIGN
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Side-by-side comparison of 2014-2015 medical plan options
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OVERVIEW OF DENTAL, VISION, & OTHER BENEFIT OFFERINGS
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PPO Dental Plan Lincoln Benefit- High Option
100/80/50 Plan design option with $1000 maximum annual benefit
Benefits for oral surgery, surgical extractions, and anesthesia will move from Type 2 coverage, covered at 80%, to type 3 coverage, covered at 50%Claims paid at 90th percentile of usual & customary fees
Coverage for dependent children up to age 26
Orthodontia included for children
Premiums
• Employee Only $35.34 per month
• Employee & Spouse $76.44 per month
• Employee & Child $70.28 per month
• Employee & Family $123.28 per month
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PPO Dental Plan Lincoln Benefit- Low Option
Provides a lower more basic level of coverage.
100/70/40 Plan design option with $750 maximum annual benefit
Benefits for oral surgery, surgical extractions, and anesthesia will be covered as Type 3 coverage, covered at 50%Claims paid at 90th percentile of usual & customary fees
Coverage for dependent children up to age 26
No Orthodontia coverage
Premium are guaranteed for 2 years
• Employee Only $25.18 per month
• Employee & Spouse $54.02 per month
• Employee & Child $48.50per month
• Employee & Family $85.22 per month
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DHMO Dental PlanLincoln Benefit- DHMO
No co-pay on office visit; many other deeply discounted services
No annual maximum benefits or deductibles
Members must choose a provider from the network to receive benefits
• Employee Only $16.80 per month
• Employee & Spouse $32.09 per month
• Employee & Child $33.80 per month
• Employee & Family $52.37 per month
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Cancer PlanColonial Cancer
Single plan option including Cancer coverage, ICU rider, Specified Disease Coverage, and 1st Occurrence Benefit
• Hospital Confinement Benefit• Radiation/Chemo• Surgery Schedule Benefit• Initial Diagnosis• Screening Rebate
$300 per day$300 per day with $10,000 per yearUp to $4,500 max$5,000$100
Open Enrollment, Guarantee issue coverage.
Employee Only $29.85 per month
Employee & Family $49.55 per month
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Vision PlanBlock Vision
Exam and eyewear co-pay of $15
Elective Contact lens allowance of $150; Paid in full if medically necessary
Frame allowance up to $125 retail value
$200 allowance on Lasik
Employee Only $7.40 per month
Employee & Spouse $12.58 per month
Employee & Child $13.30 per month
Employee & Family $19.98 per month
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Basic & Voluntary Group Term Life PlanLincoln Benefit
$15,000 Life Insurance Coverage for all Employees- Provided at no cost by Wylie ISD
Additional voluntary coverage available at group rates. ex: $50,000 Coverage• Age 25- $4.75• Age 35- $6.25• Age 45- $13.00• Age 55- $30.00• Age 65- $65.50
Spouse Coverage also available, Child Life up to age 26
Guaranteed Issue Coverage to $200,000 employee, $50,000 SpouseAnnual increases of $20,000 up to the guaranteed issue limit on voluntary life each year at open enrollment.
Coverage good while employed with Wylie ISD.
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Disability InsuranceStandard Insurance
Open enrollment, guaranteed issue opportunity in 2014
Protects against a loss of income due to sickness or accident
1st Day hospital confinement benefit- Waives elimination period on 0/7, 14/14, 30/30 elimination period plans.
Insure up to 66.67% of annual salary- $8000 maximum monthly benefit.
Elimination Period Rate Per $1000
0/7 $37.80
14/14 $33.30
30/30 $28.20
60/60 $18.30
90/90 $15.80
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Permanent Life PlanFidelity Life
Permanent, Guaranteed Issue, Life Time Protection, Term Life Insurance Policy.
Plus- Long Term Care Rider equal to 4% of death benefit, payable for 75 months. Ex: $25,000 death benefit or $1000 monthly LTC benefit payable for 75 Months.75 month LTC benefit is new for 2013, current policies include a 25 month LTC benefit
Portable upon termination of employment- Premium remains the same.
Insure yourself, spouse, and children.
Guaranteed issue for all employees up to $100,000.
Rates Based on age at issue, guaranteed for lifeex: $25,000 Non-Smoker Benefit, monthly premium:
• Age 35- $15.77 • Age 45- $26.27• Age 55- $47.50
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Medical Gap PlanSpecialty Insurance Services
Bridges the gap between Active Care 1HD and Active Care 2 benefits by:
• Paying $1,500 per year for each covered person for hospital confinement
• Paying $4,500 ($1,500 per occurrence) max per year for 3 occurrences of outpatient services – includes ER visit, MRI, x-ray, lab, outpatient surgery (excludes doctor office visit cost)
• Guaranteed issue
• No pre-existing condition if not subject to pre-existing condition on medical plan
• Also bridges the gap between Active Care 2 and Active Care 3 benefits
• Employee Only Employee Spouse >40 $25.98 $47.7640-49 $34.21 $62.8550+ $71.85 $132.02
•Employee Children Employee Family $62.45 $83.64 $67.22 $95.11 $123.81 $182.41
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Flexible Spending AccountTASC
Medical Expense Reimbursement and Dependent Care Reimbursement
Debt Card
Smart Phone and Tablet Apps
MyCash Account
Medical Expense Reimbursement Dependent Care Expense Reimbursement
Dr. Visit Co-pays Day Care Expenses
Deductible expenses Elderly Care Expenses
Rx Co-pays
Uninsured Dental/Vision Expenses
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ONSITE ENROLLMENT SCHEDULE
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Date Time LocationAugust 4th 11a.m. – 6p.m. ESC Building
August 5th – August 7th 8a.m. – 5p.m. ESC Building
August 8th 11a.m. – 6p.m. ESC Building
August 11th – August 15th 8a.m. – 5p.m. ESC Building
ESC is located at: 951 S. Ballard Avenue
Wylie, TX 75098
Open Enrollment - Enrollers Onsite
Third Party Administrator, US Employee Benefits 972-636-9944